ILBS Annual Book Report 2017

Staff Faculty Designation Dr. Shalini Thapar Additional Professor ( Radiology) Dr. Amar Mukund Additional Professor (Interventional Radiology) Dr. Yashwant Patidar Associate Professor (Interventional Radiology) Residents Dr. Jitender Singh, Dr. Lakshmi Kumar Chalamarla, Dr. Prayas Vats, Dr Shaloo, Dr. Subha Ashok, Dr. Sumit Singhania, Dr. Aniket Mondal, Dr. Lalit Garg, Dr. Swati Das, Dr. Nishant Singla Technical Staff Rajeev Dayal, Abhisek Anand, Siby George, Dhananjay Kumar Singh, Rajiv Kumar, Kuldeep Singh, Akhilesh Singh, Md Rehan, Naveen Kumar Dhillon, Md Mobasir Faiyaz, Sunil Kumar, Ms Rita Rani, Dr. Naveen Kumar Condati Nurses Tinggouneng, Kumari Bhawana Academic and Research Achievements of Faculty Dr. Shalini Thapar Laroia Dr Shalini graduated from Calicut Medical College with distinction and completed her post graduation from the prestigious Dewan Chand Aggarwal Imaging and Research Centre, New Delhi. She was awarded the National Gold medal for standing first in the all India national board examination in Radiodiagnosis. She did her senior residency training from Post Graduate Institute of Medical Education And Research, Chandigarh and G.B Pant hospital, affiliated to Maulana Azad Medical College, New Delhi. Due to her keen interest in abdominal and hepato-biliary imaging, she joined as faculty at ILBS and has done specialized work in transplant and hepato biliary imaging in the past 7 years. She was the core person involved in establishing the department of Radiodiagnosis at Institute of Liver and biliary Sciences (ILBS) with installation of Dual energy 64 slice CT scanner, 3T MRI, and Ultrasound machines with contrast ultrasound facility, portable ultrasounds, Digital X ray and Angiography suite. She has initiated and is involved in ongoing research work in the fields of MR Elastography, Multi spectral CT and contrast sonography in the department of radiology at ILBS. She is an accomplished orator and has presented various papers at national and international podiums. She has excellent publications in the field of abdominal imaging, where her core interest lies. She has more than 30 proffered papers and scientific exhibits to her credit.  Total Number of publications 23  Total Number of publications in 2017 1  Total No. of Projects 2 83

List of Projects  Research project funded by (GOI) SERB (2015 December) for 28 lakhs: Project titled Role of spectral CT in characterization of regenerative, dysplastic and malignant nodules in a cirrhotic liver: (ongoing).  Research project funded by GE. Healthcare, USA (ongoing since June 2016) Multi- Parameter Characterization of Fatty Liver disease, in collaboration with GE India Technology Centre Pvt Ltd). Conferences attended  Delivered oral paper on Inflammatory bowel disease at ECR, Vienna, March 2017.  Presented educational poster on CT enterography at the ECR, Vienna, March 2017 .  Presented educational exhibit in ESGAR, Greece 2017 on spectrum of HCC (not just wash in and wash out).  Delivered lecture on Liver transplantation imaging in intra-operative and post operative period at National IRIA conference at Jaipur, January 2017.  Delivered lecture on Ultrasound in Liver transplant at the first annual national conference of Critical Care of patients with liver disease critical care, held in New Delhi January 2017.  Delivered lecture on Imaging of ARDS at first annual conference of ECHO, held in New Delhi January 2017.  Delivered lecture on Advances in liver imaging on MRI at National conference on CT and MRI (basics to advanced) at SGPGIMER, Lucknow, May 2017.  Delivered lecture on Diffuse and focal lesions of liver on MRI at National conference on CT and MRI (basics to advanced) at SGPGIMER, Lucknow, May 2017.  Delivered lecture on Hepatobiliary emergencies: Imaging primer at Gyan. P. Lal CME organized by IRIA and ICRI at GB Pant Hospital, MAMC, New Delhi, May2017.  Delivered Lectures at AIIMS Jodhpur in First student refresher course on Liver disease and focal lesions, Jodhpur, October 2017. Details of the Awards received  J.C Bose Oration 2018 (Awarded by Indian Radiological Imaging Association).  Onco Imaging award 2018 (Awarded by Indian College of Radiology and Imaging. Dr. Amar Mukund Dr Amar Mukund, additional Professor Interventional radiology has been a key person in establishing the interventional radiology laboratory and commencing one year fellowship in interventional radiology (PDCC in HPB interventional radiology). He has plenteous publications in various national and international journals and has also authored chapters on interventional radiology and paediatric imaging. He has special interests in Hepato-biliary interventions and a few of his original works have found place in some of the distinguished 84

journals pertaining to interventional radiology. His great dedication towards his work and his friendly nature makes him a very popular faculty at ILBS.  Total Number of publications 57  Total Number of publications in 2017 4  Total number of projects 2 Dr. Yashwant Patidar Dr. Yashwant Patidar joined the institute in 2011 and is presently working as Associate Professor in Department of Interventional Radiology. He completed his M.D. Radiodiagnosis training from N.S.B.C. Medical College, Jabalpur and subsequently completed 3years of senior residency and IR training from All India Institute of medical sciences(AIIMS), New Delhi. He is an expert in all types of Interventional Radiology procedures and these includes liver and Gastrointestinal interventions like Transjugular intrahepatic portosystemic shunt (TIPS, DIPS), Balloon-occluded retrograde transvenous obliteration (BRTO),Hepatic vein recanalisation, Radiofrequency Ablation (RFA), Conventional Transarterial Chemoembolisation (cTACE), DC bead Chemoembolisation, Portal vein Embolisation, Selective internal Radiation Therapy(SIRT),Uterine fibroid Embolisation, Fistuloplasty and Emergency Interventions like Embolisation in liver trauma, pelvic trauma, GI bleeding and Bronchial artery Embolisation(BAE). He also has extensive experience in management of post liver and Renal transplant complications. Worked at AIIMS and ILBS has been a pleasurable journey and has greatly inspired and increased his dedication towards patient care and clinical research.  Total Number of publications 38  Total Number of publications in 2017 4  Total No. of Projects 2 Conferences attended  Delivered lecture in APCIO 2017 Conference at AIIMS New Delhi; Image Guided PICC Line and Central Lines.  Delivered lecture in SYNERGY- INDIA 2017 Conference Work shop (Multidisciplinary approach in Interventional Oncology) at TMH Mumbai; Chemoembolization- conventional TACE.  Delivered lecture in ISVIR 2017 Conference at Kolkata; Video session: PTBD: How I do it, including stenting.  Delivered lecture in National Conference on Critical Care and Infections in Liver-2017, under the aegis of Asian Pacific Association for the Study of the Liver (APASL), International Club of Ascites and Indian Society of Critical Care Medicine (ISCCM) on Post intervention-Hemoperitoneum and Hemothorax in critically ill cirrhotics. 85

Laboratory Medicine 86

Pathology The motto of the pathology department at ILBS is in accordance with that of the institute which strives towards excellence in quality with patient care being of utmost importance. Dexterous technical team works in unison with dedicated and motivated pathologists to attain optimum standards in every test results. The department is actively involved in academic activities with PDCC candidates being enrolled every six months, who then participate in weekly discussions and presentations. There is in totality, a holistic environment with a perfect blend of both diagnostics as well as research oriented projects. Services Rendered Services 2016 2017 HISTOPATHOLOGY 6038 6329 Small Biopsy 1095 1093 Medium Biopsy 2993 3244 Large Biopsy 2561 2553 Renal Biopsy 115 95 Liver Biopsy 1405 1482 Frozen Section 110 156 Cell Block 223 316 87

Services 2016 2017 CYTOPATHOLOGY 1359 1644 Fluid Cytology 767 909 Brush Cytology 74 114 USG AND EUS Guided FNA 342 552 Pap Smear examination 163 127 On site cytological evaluation rapid 342 552 staining and reporting New Services and Facilities  Expanded diagnostic services to cover the increasing needs of department like Nephrology, Urology, Pulmonary Medicine and Oncology.  Interactive academic and teaching programmes for PDCC Course (2 batches every year).  Clinicopathological correlation monthly meetings in ILBS and in other Institutes as and when needed.  Expanded Immunofluorescence panel.  Immunofluorescence studies for Autoimmune liver diseases as part of Biochemistry- Immunopathology services.  Expanded immunohistochemical markers for diagnostic, management and prognostic needs.  Expanded immunohistochemical markers for opportunistic infections.  Dual immunohistochemistry on formalin fixed paraffin embedded tissues.  Started liquid based cytology. 88

Educational Activities 6th Dr. V. Ramalingaswami Oration and Hepatopathology meeting was held on 8th August 2017, on the theme of “Diagnostic approach based on Liver Pathology”. This one day meeting was a rich academic session and included Oration and series of lectures by eminent National faculty. About 150 delegates turned up for this conference. The oration was delivered by Prof. Amal Kr. Santra, Professor, Center for Liver Research, I.P.G.M.E. and R, Kolkata, on Mechanisms and Implications of hepatic stellate cells activation in drug induced Liver injury. Ten senior pathologist of repute added flavor in the conference by covering ranging from morphological approach to mechanisms of diseases and fibrosis to clinical and pathology aspects of transplantation and neoplasia. Liver pathology conferences were desired more frequently by most of the delegates to fill the lacunae in liver pathology. Course Offered Course Candidates Admitted Candidates Passed Dr. Ayushi Agarwal, Dr. Neha PDCC Dr. Sowmya P.U. Nigam, Dr. Anu Chawla, Dr. Mitali (Hepatopathology) Dr. Juhi Chawla Singhal, Dr. Abhijit Chougule Department’s Achievements  Department delivered excellent quality services as per NABL and NABH standards.  6th “Dr. V. Ramalingaswami Oration” and Hepatopathology Meeting, on 8th August, 2017.  Conducted PDCC Hepatopathology courses and entrance and exit examinations.  Department provided FISH training to lab technicians.  Department provided support and service to various research projects.  Department conducted Pathology part in the CPCs.  Training of internal and external DM (Hepatology) students.  Started new diagnostic panels for various malignancies and liver diseases.  Faculty presented research work in International conferences- AASLD, APASL, ILTS, EASL.  Faculty presented ILBS work in various National conferences and meetings- ISOT.  Faculty received travel grant support from ICMR, DST.  Faculty received financial approval and grant for project from DST.  DBT Grant received for national biobank project. Visiting Faculty to the Department in 2017 Name Institution Prof. Siddharth Duttagupta AIIMS, Delhi Prof. Puja Sakuja G.B. Pant, New Delhi 89

Name Institution Prof. Malini Eapen School of Medicine, Kochi Prof. Ashim Das PGIMER, Chandigarh Prof. Amal Kr. Santra Center of Liver Research, I.P.G.M.E.and R, Kolkata Dr. Prasenjit Das AIIMS, Delhi Dr. Shashi Dhawan SGRH, Delhi Dr. Dhiraj Gautam Medanta, Gurgaon Staff Faculty Designation Dr. Archana Rastogi Additional Professor Dr. Chhagan Bihari Associate Professor Senior Residents Dr. Anu Chawla, Dr. Mitali Singhal, Dr. Abhijit Chougule, Dr. Sowmya P.U., Dr. Juhi Chawla Technical Staff Ms. Meenakshi, Mr. Amit K Sikarwar, Ms. Shagufta Anjum, Mr. Mukesh Shokeen Academic and Research Achievements of Faculty Dr. Archana Rastogi Dr. Archana Rastogi is Additional Professor in Pathology. She has done MD, DNB and Post-Doctoral Certified Course in Pathology and has been trained in prestigious superspeciality institutes in India. She is actively involved in research and diagnostic histopathology and cytopathology work in hepato- pancreato-biliary diseases and Gastro-Intestinal Pathology for last 15 years and had successfully ran the training (PDCC Hepatopathology) program for the last six years. Renal Pathology including transplant Pathology, is a special interest area and have done PDCC (Renal pathology), ANIO-CNC Clinical Nephropathology 1 year certified Course in 2016 and have experience of 4 years at SGPGI, Lucknow in the field. She has 126 publications to her credit. She has set up and standardized all the procedures in Histopathology and Cytopathology laboratories of ILBS, Delhi. She is a member of APASL-ACLF consensus group. Several important academic activities have been started by her in ILBS- Post Doctoral Certified Course (Hepatopathology), Pathology Oration and Hepatopathology Updates, monthly CPCs. She has served as Member Secretary of Institute’s ethics committee for two years and as member of Liver and kidney transplantation (external and internal) authorization for more than 6 years. Presently serving as Associate Dean of ILBS, along with her primary Pathology work. Her present research work is mainly related to liver failure, Liver Cancers and allograft rejection. 90

 Total Number of publications 126  Total Number of publications in 2017 17  Total No. of Projects 1 Conferences attended  Oral presentation in APASL, 2017, February, in Shangai, China  Oral presentation in International Liver Transplantation Socitey congress (ILTS), June 2017, in Prague.  Invited speaker for Indian Society of Organ transplantation, October, 2017  Speaker on NASH in ILBS Indo-French collaboration meeting in 2017.  Invited as chairperson and panelists in SRL, Okhla CME in September 2017; Max hospital Transplant Symposium in September, 2017; Medanta, Medicity in Surgical pathology CME in October, 2017. Dr. Chhagan Bihari Dr. Bihari completed MD Pathology from SMS Medical College Areas of interest are Oncopathology, Currently working as Associate Professor, Pathology at ILBS Vascular liver diseases, and Bone marrow dysfunction in liver diseases. He is also managing national liver disease bio-bank.  Total Number of publications 100  Total Number of publications in 2017 17  Total No. of Projects 2 Conferences attended  APDW 2017, Hong Kong  AASLD 2017 Washington DC, USA  Nanfang Hospital, Southern Medical University, Guangzhou, China  National Biobanking Workshop, TMC Kolkata, India 91

Clinical Microbiology and Infection Control Department of Clinical Microbiology and Infection Control imbibes the mission and vision of ILBS in amalgamating Clinical Research, Diagnostics, and unmatched patient care. Department is a multidisciplinary unit consisting of Bacteriology, Mycology, Parasitology, Mycobacteriology and infection control. Timebound and accurate reports forms our core strength, and provide a defining edge to evidence based medicine. Real time online reporting and use of state-of-the-art equipment have made this goal possible to achieve. Our department is the flag bearer of the Quality commitment incorporated in every aspect of ILBS. NABL accreditation validates our commitment for upholding the high standards of quality. We follow strict quality control (Q.C.) and quality assurance (Q.A.) practices, having participated in EQAS and Interlab comparisons with approved National Reference Centres for the past many years. We are proud to receive a score of 95% and above in each EQAS performance testing. Infection control activities and Antibiotic stewardship program provides continuous liasioning between the clinicians and the lab. The Infection Control Department performs surveillance of Hospital Associated Infections, monitors the environs, health care providers and the patients to prevent the spread and acquisition of MDROs and other infectious agents .We also trains and motivate all categories of staff to follow good infection control practices to prevent the spread. We have expanded our horizons in diagnostic microbiology with addition of advanced mycology testing facilities along with an array of serological tests. Our lab is well equipped and well trained for laboratory diagnosis of emerging infections like leptospirosis and scrub typhus. Department of Microbiology is dedicated for patient care services and has a prime 92

role in giving microbiological clearance for starting newer facilities in the hospital. This year we have pioneered an academic PDCC course in “Advanced diagnostic and Clinical Microbiology” which will metastasize our excellence in newer microbiological sciences to budding microbiologists. Continual proficiency development is our mission and to achieve this we encourage our staff, faculty and residents to acquire new skills through various intra departmental as well as external training. We are modern, innovative, and progressive; we value quality; and we seek to promote excellence and professionalism and to inspire the next generation of microbiologists Services Rendered Microbiology 2016 2017 Aerobic culture 28300 24655 Fungal culture 558 493 AFB culture 202 174 Stain 8628 8416 TB PCR 325 463 Serology 11974 12136 Hospital surveillance 764 850 Infection Control  The hospital has a comprehensive infection control program for Prevention and Control of Healthcare Associated Infections and multidrug Resistant Organisms.  We follow globally accepted NHSN guidelines and protocols to provide a safe environment to patient staff and visitors. Data collection and statistical analysis of HAI indices, Hand Hygiene compliance, MRSA screening form the core of infection control activities. The incidence of all major indices is weekly reported to the director of the institute and quarterly to NABH.  HAI rates of our critical areas are well below the pooled mean rates reported by INICC (International Nosocomial Infection Control Consortium) and CDC-NHSN.  New guidelines and measures are adopted to curtail the HAIs. Regular training and education and orientation of new employees and existing staff is done for Prevention and Control of Healthcare Associated Infections and multidrug Resistant Organisms.  Regular environmental surveillance in form of air culture, water culture, surface culture, 93

hand sampling is done to prevent and control any outbreak. Patient education, Oversight of regulatory compliance, isolation of potentially infectious patients. Management of Occupational exposures involving employees are important components of our routine work.  The infection control committee meets regularly on last Tuesday of every month to discuss any issues, to formulate and update patient care policies, to develop system of identifying, reporting, investigating and controlling the hospital acquired infection, and formulation of preventive and corrective programs in view of infectious hazards. Policies and protocols on the methods of sterilization and disinfection guidelines for segregation and disposal of hospital waste are regularly reviewed.  Antimicrobial stewardship: Antimicrobial stewardship forms an important component of daily infection control rounds. Discussion and review of antimicrobial treatment is carried by the infection control officer routinely. Antibiogram is prepared based on susceptibility patterns and temporal trends of aggregated data are analysed and shared. Antibiotic policy is formulated based on in-house antibiogram and globally accepted clinical guidelines. Escalation and de-escalation of antimicrobials is done to optimize the treatment and to prevent the emergence of MDROs (multiple drug resistant organisms).  The infection control manual and antibiotic policy is available on HIS (hospital information system) and can be readily accessed for referral in all areas. 94

 Restricted antimicrobials are administered only after due consideration and clearance from the concerned Faculty and infection control officer their usage monitored, quantified and rationale documented. 95

New Services and Facilities  Leptospira IgM ELISA  Galactomannan assay  Scrub typus IgM ELISA  GeneXpert for rapid MTB detection Educational Activities Courses Candidates PDCC in Advanced diagnostic and Clinical microbiology Dr. Pradheer Gupta Short term training in clinical microbiology Himanshi, Amity University Short Term Training Hands-on Workshop on”Common Microscopic Techniques for Demonstration of Microorganisms” Sanjay Mehta Topics Discussed By Infection Control Team  Spillage Management  VAP Prevention  Sample Collection  Responsibility of ICN  Bio-Medical Waste Management Rules 2016  Hand Hygiene Department’s Achievements ƒ Conducted the Delhi-NCR Chapter meet of HOSPITAL INFECTION SOCIETY - INDIA and HISI Educational and Awareness Initiative –CME. ƒ Dr. Pradheer Gupta, PDCC student participated in the workshop on ‘Quality assurance and accreditation’ at MICROCON 2017, Ranchi. ƒ Dr. Pradheer Gupta, participated in the workshop on ‘Surveillance of healthcare associated infections’ at IAMM –DC annual conference. ƒ Dr. Pradheer Gupta, presented poster on ‘Echinococcus serology has good diagnostic accuracy in patients with radiologically suspected liver mass lesions’ at MICROCON 2017, Ranchi. ƒ Training and sensitization of Housekeeping staff for Biomedical waste management. ƒ Training and sensitization program for Nursing staffs on different topics:  Factors effecting adherence to standard precautions by Nursing professionals –a Feedback exercise.  The preanalytical optimization of blood cultures the clinical importance of Preanalytical variables-refining the phlebotomy skill.  Behavioural modification for better hand hygiene compliance - Identifying the psychological barriers to compliance of hand hygiene.  Hospital associated infections-importance of critical care nursing.  Principal of sepsis and asepsis -Revising the Basics.  Disinfection of critical care equipment-training of nursing staff. Visiting Faculty Dr. Raman Sardana Indraprastha Apollo Hospital, Delhi Dr. Chand Wattal Sir Gangaram hospital, Delhi Dr. Yash Zaveri Apex Healthcare Consortium, Delhi 96

Dr. Namita Jaggi Artemis hospital, Delhi Dr. Nidhi Prasad IGIMS, Patna Dr. Sayan Bhattacharya AIIMS, Patna Dr. Vinod Pati AIIMS, Patna Mr.Anil Kumar Singh Dr.Kripa Shankar Staff Faculty Designation Dr. Vikas Khillan Additional Professor Dr. Pratibha Kale Assistant Professor Senior Resident Dr. Pradheer Gupta Technical Staff Charu Parashar, Geetha D Nair, Sanjay Singh Mehta, Sapna Sharma Infection Control Nurse Leejo Joy, Amit Chaturvedi Academic and Research Achievements of Faculty Dr. Vikas Khillan Dr. Vikas Khillan completed his MBBS, MD from UCMS, Delhi in 1999 and 2002. After working as a senior resident in GTB hospital for 3 years he joined as a National Head, Department of Microbiology at Dr. Lal Path labs, New Delhi before joining ILBS in 2008. At ILBS, he was instrumental in setting up of Departments of Clinical Microbiology and Infection control. Along with handling Bacteriology, Mycobacteriology, Parasitology and Mycology sections of the lab, he is actively involved in antibiotic stewardship, infection control activities and biomedical waste management of the hospital. He developed antibiotic policy, infection control manual and quality manuals for the hospital. He emphasized hand hygiene training, surveillance of OTs and monitoring of infection control indicators like CRBSI, SSI, VAP, and CAUTI at ILBS. He is helping clinicians in rational use of antibiotics during his rounds in critical areas of hospital. He is a coordinator for all NABL related activities of the labs in the capacity of “Technical Manager” laboratory medicine. He is a co-chairman of infection control committee and a member of drug and therapeutic committee at ILBS. He is actively involved in the NABH certification and other hospital certification activities like Kayakalp. Started post doctoral certificate course in advanced diagnostic and clinical microbiology.  Total Number of publications 12  Total Number of publications in 2017 4  Total Number of projects 5 97

List of Projects  PI for “Characteristics and comparison of diagnostic methods for pulmonary and extrapulmonary mycobacterial infections in liver diseases: A record based study” October 2017.  PI for “Incidence, microbial etiology and outcome of early onset pneumonia in liver transplant recipients” December 2017.  Co- PI for project: Title: Molecular and serological methods for rapid diagnosis of fungal infections in chronic liver diseases.  Co-PI for “Efficacy and safety of prophylactic empirical antibiotics in the prevention of bacterial infection in patients of acute on chronic liver failure- a randomized controlled trial” December 2017.  Co-PI for “Efficacy and safety of prophylactic empirical antibiotics in the prevention of bacterial infection in patients of acute on chronic liver failure- a randomized controlled trial” December 2017. Conferences attended  Faculty lecture in Delhi-NCR Chapter meet of Hospital Infection Society - India and HISI Educational and Awareness Initiative.  Faculty lecture in 1st national conference on critical care and infections in liver diseases at ILBS.  Presented paper in FIDDSA conference, South Africa.  Presented paper in national conference of IAMM, Ranchi.  Attended CME on zoonotic infections in India and emerging challenges of associated bio safety organised by CDC and ASM.  Chaired a session in 15th National conference of critical care medicine –Delhi-NCR  Invited as a judge for poster competition at Annual MICRO D-CON.  Delivered series of lecturers at ILBS during “certificate course in critical care nursing”. Dr. Pratibha R Kale Dr. Pratibha Kale has graduated from Government Medical College, Aurangabad, Maharashtra and MD, Microbiology from PGIMER, Chandigarh with senior residency from AIIMS, New Delhi in 2015. Dr. Pratibha has accomplished her DNB in 2013 and garnered the Membership of National Academy of Medical Sciences in 2017. Dr. Pratibha is an NABH assessor. She has partaken in the Infectious Disease Certificate Course in 2014. Her major research interests are mycology, post transplant infections and multidrug resistant pathogens. Dr. Pratibha is the member secretary of the Hospital Infection Control Committee. She is Associate of Royal College of Pathologists, London and the exam co- ordinator for FRCPath examination. 98

She has received academic bronze medal at PGIMER and Dr. Bederkar Award for Physiology (2002). Received G.P. Agarwal Young scientist award, best oral paper presentation on “Comparison of responses of Aspergillus flavus and Alternaria alternata on activation and degranulation of eosinophils in allergic fungal rhinusinusitis”SIHAM, 2012. She has received NAWOPIA Dr. Pankajalakshmi V. Venugopal Prize for Best Paper in Mycology” at MICROCON 2014, USTI- IASSTD and AIDS Scholarship worth Rs 20,000 for at ASTICON 2014 and IAMM Silver Jubilee Best paper in parasitology, MICROCON 2015. Dr. Pratibha has received travel grant award from Indian Society of Hematology and Transfusion Medicine (ISHTM). She has received First Prize in Essay Writing Competition in Vigilance Week PGIMER Chandigarh.  Total Number of publications 15  Total Number of publications in 2017 6  Total No. of Projects 5 List of Projects  PI project for “Molecular and serological methods for rapid diagnosis of fungal infections in chronic liver diseases”. Funding agency: Department of Science and Technology, Start date: December 2017.  Co-PI for “Characteristics and comparison of diagnostic methods for pulmonary and extrapulmonary mycobacterial infections in liver diseases: A record based study” October 2017  3. Co-PI for “Incidence and predictors of ventilator associated pneumonia in Cirrhotic and non Cirrhotic patients” October 2017-12-12  Co-PI for “Incidence, microbial etiology and outcome of early onset pneumonia in liver transplant recipients” December 2017-12-12  Co-PI for “Efficacy and safety of prophylactic empirical antibiotics in the prevention of bacterial infection in patients of acute on chronic liver failure- a randomized controlled trial” December 2017 Conferences attended  Faculty lecture in GISICON October 2017, Bhopal on “Intra-abdominal Fungal Infections.”  Invited faculty and paper presentation at CIDSCON August 2017, Nagpur on “Prognostic Significance of Serum Procalcitonin Level in Critically ill Patients with Ventilator Associated Pneumonia in Liver Diseases”  Presented paper in IAMM Delhi Chapter February 2017, AIIMS, New Delhi on “Prevalence and profile of Mycobacterial infections in liver disease: Zilch but exceptions”  Presented paper at IAMM DC Annual conference on “Prognostic Significance of Serum Procalcitonin Level In Critically ill Patients With Fungal Pneumonia In Liver Diseases”  Organizing committee member of Delhi-NCR Chapter meet of Hospital Infection Society - India and HISI Educational and Awareness Initiative –CME  Steering committee member for NAAC peer team visit June, 2017.  Co-ordinator for nursing and school program for hepatitis day. 99

 Comparing of the `Hepatitis day December 2017.  Comparing of the World Hepatitis day Program, July 2017.  Editorial team member for Annual report 2017.  Reviewer for Clinical and Experimental allergy, Microscopy Research and Techniques. Awards  Best poster award at IAMM DC, February 2017, AIIMS, New Delhi on “Prevalence and profile of Mycobacterial infections in liver disease: Zilch but exceptions”.  Awarded “Associateship of Royal College of Pathologists, London”.  Awarded “Member of National Academy of Medical Sciences”.  Essay on ‘What can I do for a Clean India’, selected and published on mygov.in. 100

Clinical Virology Clinical Virology Laboratory at the Institute provides a full range of diagnostic services for the detection and monitoring of viral illnesses in both the adult and pediatric patient. Most of the functioning of the department has been automated to an extent, in keeping with international standards. The laboratory performs diagnostic services for the detection and monitoring of viral diseases for the full range of Hepatitis viruses (Hepatitis A, B, C, D and E). The laboratory is fully equipped to diagnose and monitor all most all the viruses causing infections in transplant recipients and other immune compromised patients. A BSL level grade 2/3 molecular diagnostic facility is available in the molecular set up. Viral genotyping is routinely being done. Multiplex Real time PCRs is the strength of the laboratory including Respiratory viral PCR for 33 different pathogens together. The laboratory takes pride in performing several diagnostic assays for the first time in the country, like testing for drug resistant substitutions in HCV (RAS), antiviral drug resistance testing in HBV; HBs Ag quantification in clinical samples ; testing for Occult HBV infection and cccDNA in biopsy samples; screening for various mutations in HBV like Pre-core, Basal core promoter mutations; HEV RNA Quantification and genotyping; EBV and CMV Quantification in tissue biopsy samples. Furthermore, the laboratory is actively involved in the investigation of any outbreak that grips the city like recent Influenza, Dengue and Chikungunya outbreaks in the capital. Recently, point of care of Molecular diagnostics was started in the laboratory in assays like HCV RNA, H1NI and HIV viral load testing. Microarray platform for syndromic viral infection testing is also available in the laboratory. Virology laboratory takes pride in being made as one of the testing laboratories by Central Drugs Standard Control Organization for the validation of Hepatitis diagnostic kits. Virology laboratory at ILBS is also nominated by ICMR as one of the Apex Viral Hepatitis laboratories in the country to look after external quality assurance (EQAS) in various Virology labs across the Nation. The lab has been active in initiating teaching modules and programs in clinical virology. NABL accreditation was awarded to the lab in 2013 and is the one of the very 101

few NABL accredited molecular virology lab in India. The Molecular Lab participates in EQAS by Royal College of Pathology, Australia. The Virology Lab has made an exhaustive protocol for Needle Stick Injuries, post exposure prophylaxis for healthcare professionals at ILBS and also keep a track of the HBV immunization status of the entire ILBS staff. The laboratory also supervises the unique Needle stick injury control programme through our website (www.nsi.ilbs.in). This website aims to provide platform for a centralized registry for needle stick injuries. The vision of ILBS is not only to create an institutional database on needle stick/ sharps injuries but to expand it as a statewide and thereafter national NSI Registry. A unique PDCC course in Hepatovirology has been introduced from August 2014 to train young budding microbiologists in this field. As a part of World Health Organization collaborative Center (WHO-CC) in Viral Hepatitis, Virology laboratory is actively involved in imparting capacity building training to Microbiologists and other laboratory sta across the Nation. Services Rendered Serology  Hepatotropic viruses (HBV, HCV, HAV, HEV, HDV ).  Transplant related viruses (CMV, EBV, HSV, VZV and BK virus).  Human Immunodeciency Virus.  Vector borne viruses: Dengue, Chickungunya.  Special serological (quantication) assays – HBs Ag quantication, Core IgM, HEV antigen. Molecular Virology  Hepatotropic viruses (HBV, HCV, HAV ,HEV,HDV ) by Real-time PCR.  HBV, HCV genotyping and HBV mutation screen  Transplant related viruses (CMV, EBV, HSV 1and2 ,VZV,BK)  HBV drug resistance testing.  HCV Resistance Associated substitutions Testing(RASs)  Occult HBV testing.  Real time PCR for cccDNA in clinical samples.  Real time PCR for Dengue, Chikungunya.  Real time PCR for Inuenza and other respiratory viruses.  Microarray based testing for Viral syndromes. Needle Stick injury protocol  Post-exposure testing and counseling. HBV vaccination and anti-HBs (titer determination)  HBV vaccination at recruitment.  Determination of anti-HBs (titer) post vaccination. 102

Services 2016 2017 Serology HBV 19490 21154 HCV 8706 10221 HAV and HEV 3391 3831 CMV 2498 2328 HIV 1and2 3894 4125 Dengue Virus 572 413 Chikungunya 98 22 Special Serology (HBsAg Quantication) 1900 1910 EBV , HSV , VZV 180 193 HDV 58 61 Molecular Assays HBV DNA Quantitative (Real Time PCR) 2956 2880 HCV RNA Quantitative (Real Time PCR) 3192 2254 HAV and HEV RNA Quantitative (Real Time PCR) 141 144 Transplant Related Viruses DNA Quantitative (CMV, EBV, HSV 900 803 1and2 and VZV) Genotyping HBV and HCV 500 397 HBV Drug Resistance Testing 15 08 Respiratory Virus PCR 40 139 HCV RAV Testing 05 13 BK VIRUS (Real Time PCR) 18 34 Pre Core and BCP Mutations Analysis 01 01 HIV Viral load - 01 H1N1(Swine Flu) Qualitative - 110 Rapid HCV RNA Quantitative - 18 103

Services 2016 2017 Adeno CMV EBV PCR - 06 Determination Of Immunity To Hbv Post Vaccination Staff Anti-Hbs( Titer) 174 323 Pre-Employment Health Check Up HBsAg 123 148 Anti-HBs(titer) 123 148 Anti HCV 123 148 SERVICES ADDED (Tests done in Free Health check up camps - 2017) HBsAg 552 237 Anti-HCV 552 237 TOTAL 50671 52308 New Services and Facilities  HIV 1 Viral load testing  H1N1 Qualitative PCR  Rapid HCV RNA Quantitative PCR by  Adeno CMV EBV multiplex PCR GeneXpert 104

Sequencing Services Oered  HBV Genotyping  HCV Genotyping  HBV Drug Resistance testing  HBV Precore and Basal Core Promotor mutations  HCV drug resistant associated mutation analysis Course Offered Course Candidates Candidates Passed PDCC in Hepato-Virology 03 03 Short Term Training Name Of The Training Candidates Passed Renu Singh, CCS University, Uthara Devi AS, Amity Short Term Training in Clinical Virology University, Mitali Srivastava, Amity University Visiting Faculty To The Department In 2017 Name Institution Date Of Visit Dr. Priya Abraham CMC, Vellore 19.06.2017 Dr. Bharti Malhotra SMS, Jaipur 19.06.2017 Dr. Nidhi Prasad IGIMS, Patna 01.11.17 to 11.11.2017 Dr. Abhay IGIMS, Patna 15.10.17 Dr Anita Chakravarti MAMC,Delhi 16.12.17 Dr. Renu Gupta IHBAS,Delhi 16.12.17 Dr. Manoj Kumar Scientist, NIB Dr. Manjula Kiran Scientist, NIB Staff Faculty Designation Dr. Ekta Gupta Additional Professor Senior Residents Dr. Supriya Mahajan, Dr. Shipra Goel, Dr. Mousumi Paul, Dr. Pradheer Gupta, Dr. Sujata Lall, Dr. Ayushi Tayal Technical Staff Gaurav Singh, Nand Kishore Sharma, Keshaw Kumar Singh, Jagat Singh, Piyush Bahuguna, Hemlata Free HBV and HCV Screening Camps  Organized Hepatitis B and C screening camp on the occasion of Hepatitis Day on 4th Dec, 2017. Total 237 registrations were done in the camp.  Will be a part of the “Mobile screening campaign” launched by ILBS this year. 105

Educational Activities  As a part of capacity building and laboratory network strengthening, Virology laboratory imparts regularly training to various levels of laboratory professionals on Viral Hepatitis testing. The Department organizes regularly one day hands-on technician training programme. This involves series of lectures on various aspects of Viral Hepatitis testing, hands on training in various laboratory techniques and group discussions. Till now more than 80 laboratory technicians from Delhi state AIDS control society have been trained by the Department.  Organized a lunch symposium on “Approach to Syndromic testing in viral infections” on 24th August. Representation of the Department by the Residents at various National Conferences  Mousumi Paul, Oral presentation:- Secured third position in oral presentation in the topic “Increasing prevalence of Pre- core and Basal core promoter mutations seen in hepatitis B e antigen positive patients with chronic hepatitis B infection” in the National Virology conference conducted by CMC Vellore, July 2017.  Ayushi Tayal was awarded Dr. Ashok Chakravarti memorial award in poster competition on “ Molecular characterisation of Chikungunya virus strains isolated from 2016 Delhi outbreak revealed emergence of a novel mutation in E1 gene.” In the IAMM DC Annual conference ,Dec 2017.  Pradheer Gupta, Akshay Batra,Manish Chaudhary, Guresh Kumar, Meenu Bajpai, Ekta Gupta. “ Platelets as an extrahepatic reservoir of HCV-RNA : A prospective study.” Poster presentation in National Virology Conference, CMC Vellore , July 2017. Awarded 3rd prize.  Sujata Lall, Pragya Ranjan, Guresh Kumar, Ekta Gupta. Quantitative IgM core antibody could be a reliable marker in dierentiation of acute hepatitis B (AHB) from chronic hepatitis B with acute exacerbations (CHB-AE). Poster presentation in National virology conference, CMC Vellore , July 2017.  Sujata lall, Pragya ranjan, Guresh kumar, Ekta Gupta. Poster presentation-Assessment Of Serological Assays For Solving the Dilemma Between Acute Hepatitis (AHB) And Chronic Hepatitis B with Acute Exacerbation (CHB-AE) in CIDSCON 2017 at Nagpur.  Ayushi tayal, Supriyamahajan, Priyanka jain, Ekta Gupta. Prevalence and outcome of Herpes Virus infections in solid organ transplant recipients: A report from tertiary care transplant centre. Oral presentation at National Conference of Indian Association of Medical Microbiologists (MICROCON 2017) held at RIMS, Ranchi on 25th November 2017.  Supriya Mahajan, Vijeta Bajpai, Priyanka Pandey, Sonam Makhija, Ekta Gupta. Distribution and prevalence of Hepatitis B virus genotypes in hepatitis B infected patients and their role in disease severity. Oral presentation in National conference of Indian Association of Medical Microbiologists (MICROCON 2017) held at RIMS, Ranchi on 25th November, 2017. 106

Academic and Research Achievements of Faculty Dr. Ekta Gupta Dr. Ekta Gupta did her MD Microbiology from KGMC Lucknow, Senior Residency from AIIMS, New Delhi and Senior Research Associate ship in Clinical Virology from AIIMS. She was granted Gold Medal for her MD. Did post MD research work in Dengue viruses for which “The best Scientist award for outstanding con - tribution in clinical research by Indian Council of Medical Research (ICMR)”was given. Major research interests are in Hepatitis Viruses, Transplant viruses and Dengue virus. Have more than 70 scientic publications in indexed National and International Journals and author of 11 chapters in books. She is the Nodal ocer for Hepatitis Day which is celebrated annually on 4th December in the Institute, she is actively involved in organizing various social level screening and vaccination camps for HBV and HCV in general public. She is the course faculty for the WHO CC and ECHO program at the Institute. She is the member secretary of the Institute’s Ethics and Review board (IEC/IRB). She is an active member in many other Institutional committees and various other committees outside the Institute. She has to her credit several extramural research grants both at National and International level. She has been instrumental in initiation of a unique PDCC course in Hepato-virology at ILBS for MD Microbiology students. She is also a part of Technical resource person for developing the National Viral Hepatitis Control Program in India.  Total Number of publications 73  Total Number of publications in 2017 4  Total No. of Projects 5 List of Projects  Evaluation of HBV Surface antigen quantitation as a monitoring tool for CHB patients on treatment (Extramural and ICMR Funded - Completed).  Study of Transplant related Herpes viruses in allogenic liver transplant recipients (Extramural and ICMR Funded - Completed).  Field evaluation of the performance of HCV serological RDT in HCV/HIV co-infected patients.(Extramural ,MSF Epicenter).  To study the prevalence of Resistance associated substitutions (RASs) in HCV patients and its correlation with anti-viral treatment response.(Extramural: DBT)  Development of Apex Viral Hepatitis Quality laboratory for various Viral diagnostic research labs in India (Extramural , ICMR). Conferences attended  Delivered faculty lecture at 1st National Conference of Critical Care and Infections in Liver Disease at ILBS Jan 2017 on “ Viral pneumonia in critical care settings”.  Guest lecture on “Signicance of Viral load testing and genotyping in Hepatitis B and C infections” in 6th Annual Conference of Molecular Pathology Association of India ,held 107

at KIIT University, Bhubaneswar Feb 2017.  Guest speaker at Symposium on “Newer Diagnostic Methods in Infectious Diseases” at 10th Foundation Day of Molecular Diagnostic Reference Laboratory, Kasturba Hospital Mumbai, June 2017  Faculty lecture on “ Antiviral resistance testing in HCV in the era of DAA” in “National Virology Conference” held at CMC Vellore, Tamil Nadu, July 2017  Presented paper on “ Post transplant CMV infection: role of pre-transplant CMV serology” at 20th ESCV 2017 Annual Meeting, Stresa, Italy in September 2017.  Faculty lecture on “Drug Resistance in Hepatitis C virus in the era of DAA therapy” in AIIMS, Bhopal, Oct 2017.  Faculty lecture on “ Leveraging existing training programs at ILBS” on 28th July on the occasion of World Hepatitis day at ILBS.  Faculty lecture on “ Ethics in Medical practice” in a CME on Biostatistics and Hands on Practices on Medical Data Using SPSS software, Delhi ,Aug 2107.  Invited speaker in World Hepatitis Submit at Sao Paul, Brazil, Nov 2017, spoke on “ Relevance of implementation of institutional policy to protect health care workers exposed to Hepatitis B virus (HBV ) or Hepatitis C virus (HCV ) –contaminated blood or body uids: experience from a tertiary care liver centre in India.”  Faculty lecture in Annual conference of IAMM MICROCON 2017 at RIMS, Ranchi on “ Quality control in viral hepatitis testing” and “ Viral infection in solid organ transplant recipients” Nov 2017  Faculty lecture in Annual conference of IAMM DC on “ Viral hepatitis testing: newertrends” in Delhi ,Dec 2017.  Faculty lecture on “ Laboratory diagnosis of Viral hepatitis” and “Needle stick injuries and PEP for HCWs” in ECHO sessions at ILBS. Other Academic Activities  Organised three technician training workshops at ILBS on “Laboratory diagnosis of Viral Hepatitis” as WHO CC. Faculty lecture on “Laboratory diagnosis of Viral Hepatitis”.  Member secretary of Institutional Review board, ILBS.  Member, Institutional Review board of Jamia Millia Islamia University.  External examiner for PhD thesis at Jamia Millia Islamia University.  External examiner for MD Microbiology at Vallabh Bhai Patel Chest Institute.  Member of the 3 technical working groups in development of the National Viral hepatitis Program for India.  Nodal Officer in organizing Hepatitis Day, at ILBS on 4th Dec.  Nodal Officer in organizing World Hepatitis Day at ILBS on 28th July. Awards  Awarded WHO Scholarship to participate and present paper in World Hepatitis Summit at São Paulo, Brazil, Nov 2017. 108

Biochemistry Clinical biochemistry measurements form the scientific basis upon which medical diagnosis and management of patients is established. The biochemistry lab excels in responding to pressures for even greater accomplishments in areas of informatics, advanced analytic methods, interpretation of complex data, and communication of medical information in a meaningful way to physician colleagues. Paramount is the manner in which the laboratory has mustered its resources in high end equipments, trained personnel, high grade reagent supply and ingenuity of its leadership to respond to the need of healthcare providers and patients in terms of access, timeliness , cost and quality of test results . The labortaory caters to core biochemistry, critical care, immunology and immunopathology in addition to keeping abreast with recent major advances in the field of clinical biochemistry. The testing methodologies span a vast panorama from colorimetry, nephelometry ,CLIA, ELISA ,Western blot to Immunofluorescence. It also plays a role in total quality management and continual quality improvement through medical, scientific and technical expertise. Besides the cost effective services the laboratory also actively participates in educational and research activities together with participation in public health initiatives for prevention of liver diseases. This year 13 new tests were added to the scope of NABL accreditation. A new software Unity Real Time was added to strengthen our quality assurance. Four new instruments have been added –Maglumi 2000plus ,DXI Immunoassay analyser, Helia automated blot analyser and Nephelometer which has enabled us to respond to increased volumes of testing and complexity of measurements and examinations. A few tests like plasma renin activity (PRA), NTproBNP and vitamin D have been started on Maglumi 2000plus which has been upgraded and resulted in cost reduction in these tests. New tests include serum IL-18, serum NGAL, urine GGT, serum adrenaline , serum noradrenaline and serum aldosterone . 109

The laboratory extends its research support for thesis programme of DM/MCH / PDCC projects to various of the departments of ILBS. The department has actively participated in organizing Hepatitis day camps and also teamed up for “ Healthy liver, Healthy Delhi” project of ILBS with Mylan pharmaceuticals. Services Rendered Services 2016 2017 Routine 233444 233490 Fluids 9788 9384 Urine Tests 7731 7646 Endocrinology 16351 17820 Oncology 11211 11054 Immunology 7214 6904 Inflamatory Markers 3983 3566 Serology 1268 1065 Autoimmune Markers 6201 6381 Therapeutic Drug Monitoring 3611 3605 Liver Transplant Chemistry 236 243 Bone Metabolism 2171 2122 POCT 151063 143076 Allergy Profile 67 87 Out Sourced 1657 1581 Total Tests 455996 448024 New Services and Facilities New Tests  NTproBNP  Plasma Renin Activity (PRA)  Serum Adrenaline  Serum Noradrenaline  Serum Aldosterone  Serum IL-18  Serum NGAL  Urine GGT 110

New Instruments  Maglumi2000plus  DXI Immunoassay analyser  Helia Immunoblot analyser  Nephlometer New Software  Unity Real Time for internal quality control New expansion of Scope of NABL by following tests  Serum Ceruloplasmin  Serum Complement C3  Serum Complement C4  Serum LDL  Serum Immunoglobulins (IgG, IgM, IgA and IgE)  Serum C Reactive Protein (CRP)  Serum Ferritin  Serum Rheumatoid factor (RA)  Serum Lipase  Serum Bicarbonate Educational Activities  Co-supervisor in DM /MCH/PDCC thesis/projects.  Was a moderator in a workshop on autoimmune diseases and diagnosis - An update September 13-14th 2017 in Chennai.  Given observership training to various visiting doctors from IGIMS Patna, Bihar in clinical biochemistry, immunology and immunopathology. Course Offered Short term courses in Immunology and Clinical Automation Short Term Training Name Of The Training Candidates Observersip Training in clinical biochemistry, Dr. Vijayanand Choudhary, Dr. Abhay Kumar, Dr. Sanjeet immunology and immunopathology Kumar, Dr. Nidhi Prasad Department’s Achievements  According to our External Quality Assurance results our lab is amongst the best in the world.  Added new biochemical tests which is benefiting the patients and helping clinicians for effective patient diagnosis.  Research work co-supervised in the department has resulted in timely submission of various thesis projects in department of the hepatology, hepatobiliary surgery, transplant anaesthesia and nutrition. 111

Staff Faculty Designation Dr. Sherin S. Thomas Consultant Senior Resident Dr. Navneeta Mishra Technical Staff Manoj Kr Sharma, Mahesh Hooda, Preeti Manchanda, Ritu Goyal, Ravi Thakur, Dhruv Kumar, Sourabh Dagar, Mukesh Bhandari, Abhishek Singh, Sachin Academic and Research Achievements of Faculty Dr. Sherin S. Thomas Dr. Sherin S.Thomas is a consultant in the department of Biochemistry and has done her M.B.B.S in 1994 from Maulana Azad Medical College and M.D. in Biochemistry in 2001 from V.P. Chest Institute, New Delhi. She is a merit scholar of the Delhi government during M.B.B.S. She has close to 17 years of experience in the field of biochemistry. Under her leadership a well structured organisation exists in the department of biochemistry with competent direction and management. She has incorporated informatics, advance d analytical methods, interpretation of complex data and communication of medical information in meaningful ways to physician colleagues and has also taken initiatives to promote outstanding healthcare in a socially responsible endeavour. She has added various new tests to the scope of accreditation of NABL this year and promoted high quality of reports. She is a co supervisor in various DM/MCH/PDCC thesis/projects She has also given observership training to many visiting doctors.  Total Number of publications 14 Conferences attended  Was a moderator in a workshop on Autoimmune diseases and diagnosis-An update- September 13-14th 2017 in Chennai. Future plans : Better health and healthcare in the field of liver and biliary sciences through biochemistry  A single influential, academic organization with an entrepreneurial approach.  High quality patient care through effective and efficient use of laboratory resources and to decrease turnaround time of biochemistry tests and introduction of details of sample collection in a brochure for patients.  Engage in laboratory assay development,optimization and evaluation like automation of immunoblot and ELISA tests. 112

 Training of postgraduates and residents in Medical Biochemistry and education of Medical Laboratory Technologists.  Participate in public health initiatives like ‘Healthy Liver Healthy Delhi’ project with Mylan pharmaceuticals. 113

Haematology and Clinical Pathology The Department of Haematology and Clinical Pathology is a holistic unit which caters to patient care, laboratory services and clinical research. It represents a unique amalgamation of laboratory and consultative haematology dedicated to clinical as well as diagnostic aspects of patient well being. The NABL accredited lab is well-equipped with advanced automated technology for carrying out haematological investigations besides providing consultative services in the diagnosis of haematological diseases and disorders. Services Rendered Investigations 2016 2017 Haematology Routine Absolute Counts 181 442 Complete Blood Counts 53860 59764 Complete Hemogam 9879 9926 Esr 343 421 Hb/Pcv 6153 4212 Rbc Indices 00 04 Malaria Antigen 381 307 Platelet Count 619 504 Tlc And Dlc 1237 648 Peripheral Smear Examination 723 771 114

Haemolytic Workup G6pd Deciency Test 414 490 Hb HPLC 129 123 PNH Test 12 17 Reticulocyte Count 2427 2340 Bone Marrow Evaluation Bone Marrow Aspiration Procedure And Reporting 265 311 Bone Marrow Biopsy Procedure And Reporting 245 302 Iron Stain 265 311 Coagulation Lab Services Prothrombin Time 42391 45405 Activated Partial Thromboplastin Time 3430 3438 Von Willebrand Antigen 03 02 Sonoclot Assay 145 67 Fibrinogen Assay 1749 2033 Protein C 150 151 Protein S 153 151 Antithrombin III 123 133 Fibrin Degradation Products 67 76 D-Dimer 103 104 Factor VIII Assay 138 153 Bleeding Time 12 25 Clotting Time 09 25 Clinical Pathology Urine Routine And Microscopy 10817 11758 Urine For Reducing Substance 148 149 Urine For Ketones 162 172 Urine For Bence Jones Protein 36 49 Fluid TLC And DLC 8935 5031 New Services and Facilities  Department has started stat and 24x7. Hematology services.  Department has procured a new automated coagulation analyzer Sysmex CS-2400 to perform automated mixing studies, automated platelet aggregation and clot waveform analysis.  ELISA based factors assessment of components of coagulation pathway.  Department is in the process of getting cryo-equipments.  Department provided hematological analysis for animal studies. Eosinophilic VCS arameters, namely, MEV (Mean eosinophil volume) and MEV-SD (eosinophil size variability) using Coulter haematology analyzer LH750 (Beckmann Coulter) in patients 115

suspected of drug induced liver injury (DILI). Patients with DILI have increased levels of MEV and MEV-SD compared to other patients. Department’s Achievements  Department of hematology and clinical pathology is committed to deliver excellent quality services as per NABL and NABH standards.  Department provided observership and short term training in hematology.  Department provided support and services to various research projects.  Senior Resident presented her work on “Sonoclot Signature Analysis Predicts Coagulopathy in Cirrhosis” in Haematocon 2017, held in Guwahati from 2 nd - 5 th November, 2017.  Senior Resident submitted work on “Decreased Protein C Function Predicts Mortality in Patients with Cirrhosis” to AASLD 2017, which was accepted for poster presentation. Staff Faculty Designation Dr. Chhagan Bihari Associate Professor Senior Resident Dr. Anupama Patil Technical Staff Mrs. Rekha Suryan, Mr. Parveen Kumar, Mr. Surendra Raj, Mr. Yashpal, Mr. Kamlesh Yadav, Mr. Rinku Bajpai, Ms. Sarweshwari, Mr. Yugant 116

Academic and Research Achievements of Faculty Dr. Chhagan Bihari Dr. Bihari completed MD pathology from SMS Medical College. His areas of interest are Oncopathology, Vascular liver diseases, and Bone marrow dysfunction in liver diseases. Currently he is working as Associate Professor, Pathology at ILBS.  Total Number of publications 100  Total Number of publications in 2017 17  Total number of projects 2 Conferences attended  APDW 2017, Hong Kong  AASLD 2017 Washington DC, USA  Nanfang Hospital, Southern Medical University, Guangzhou, China  National Biobanking Workshop, TMC Kolkata, India 117

Clinical and Cellular Transplant Immunology The clinical and cellular transplantation Immunology at Institute of Liver and Biliary Sciences is a state of the art histo-compatibility and immune-genetics testing laboratory that supports busy clinical transplant programs and transplantation research activities. In ILBS overarching goal of Clinical and Cellular Transplant Immunology unit is to provide the comprehensive diagnostic tests related to liver and kidney transplants as well as for graft rejections. The human leukocyte antigen (HLA) test, also known as HLA typing or tissue typing, identifies antigens on the white blood cells (WBCs) that determine tissue compatibility for organ transplantation (that is, histo-compatibility testing). Clinical and cellular transplantation Immunology laboratory at ILBS uses DNA-based molecular diagnostic techniques to identify HLA genes at low allele resolution by PCR-SSP (polymerase chain reaction-sequence-specific primers) for kidney and liver transplants. In addition to this laboratory performs investigations for determination of HLA B-27 also. HLA-B27 is strongly associated with a certain set of autoimmune diseases like ulcerative colitis, inflammatory bowel disease and Crohn disease. Patients with graft rejections may have circulating antibodies that recognize HLA antigens on a donor organ or tissue and experience rapid and irreversible destruction of the graft upon transplantation. Even low levels of antibodies may damage the grafts, so more sensitive antibody tests are used for cross-matching and for identifying the risk of immune antibody-mediated damage. Clinical and cellular transplantation Immunology laboratory at ILBS also provide services for Panel Reactive Antibody (PRA) test to rule out any reaction against pre-existing antibodies. We also performs complement dependent cytotoxicty (CDC METHOD) HLA-Cross match Tests and HLA-Cross match by flow cytometry to detect antibodies that react with donor HLA antigens prior to transplantation. The complement-dependent cytotoxic cross-match test detects the presence of alloantibodies in pre- and post-transplant patients, which may dictate clinical management of transplant patients. Cross-match tests are used primarily for transplant candidates to assess the suitability of a potential donor. Our laboratory also provide services for monitoring of phenotypic characteristics of Tlymphocytes (CD4 and CD8 cells) in peripheral blood, which is commonly performed in the management of human immunodeficiency virus (HIV) positive and chronic hepatitis patients. It also performed to monitor of organ transplant especially in kidney transplant patients to allow us to minimize adverse events of immune-suppression. 118

Services Rendered HLA Typing  HLA DNA Typing ABDR  HLA B-27  HLA DQ2/DQ8 Tissue Rejection Panel  Complement-Dependent Cytotoxicty analysis.  HLA-Cross Match by flow cytometry.  Donor Specific Antibodies ( DSA). Immune Phenotyping  Immuno phenotyping for CD4 T cells and CD4/CD8 T cells ratio for HIV monitoring.  Immune deficiencies analyzing the antiviral drug monitoring.  Immune deficiencies of regulatory T cells in autoimmune hepatitis.  Immune Deficiency of NK/NKT cells. 119

Staff Faculty Designation Dr. Nirupma Trehanpati Additional Professor Technical Staff Mr. Arun, Mrs. Surinder Kapoor, Mr. Dileep Singh Academic and Research Achievements of Faculty Dr. Nirupama Trehanpati Complete faculty profile given under Dept of Molecular and Cellular Medicine.  Total number of publications 62  Publications in 2017 14  Total number of projects 3 120

Genetics The importance of investigating genetic perturbations in diseased individuals is highlighted by the fact that many such alterations, in form of single nucleotide polymorphisms (SNP), would be inherited by the offsprings of the diseased individual. Capturing such information would develop a resource base that could be used to understand the disease or treat the patients of the next generation more effectively. Keeping this larger interest of the society and to better the treatment options, ILBS initiated genetics services in 2011. ILBS is amongst a handful of hospitals in the country that carryout genetic investigations for liver diseases. Genetics is an indispensible field for disease related research. More than 4700 patients have been screened for genetic disorders leading to liver diseases since the department started. With rapid pace of research new genes are being identified that correlate with liver diseases eventually resulting in the increase in the number of patients that are now being screened for liver disorders. The Department screened over 1100 samples in the past year. The department supports clinical and research faculty, fellows, students and staff by providing them scientific and technical inputs to meet their research goals. The Department of Genetics provides single nucleotide polymorphism (SNP) analysis for the following diseases:  IL28B – Mutation in this gene is associated with poor immune response during HCV infection.  ITPA – Associated with increased risk of anemia in HCV patients on ribavarin treatment.  TATA box – Polymorphism in the promoter region of UDP glucuronosyltransferase 1 family, polypeptide A1 (UGT1A1) results in a defective enzyme leading increased unconjugated bilirubin in circulation.  MTHFR, Factor-II and Factor-V – The SNPs in these gene area ssociated with thrombosis disorders resulting in hypercoagulability.  ATP7B – Either of the 200+ mutations in this gene result in ccumulation of coppoer in body parts and is classified as Wilson’s disease.  HFE – The polymorphisms in the gene are responsible for increased accumulation of iron in the liver.  SPINK1, CFTR – Both these genes are responsible for regulating hte trypsin production pathway in pancreas; mutations result in pancreatitis.  JAK2 – Polymorphism in this gene is associated with Budd-Chiari syndrome often as a complication of polycythemia vera.  PNPLA3 – SNPs in this gene are associated with non-alcoholic fatty liver disease and steatohepatitis. 121

 TPMT – The immune suppressant azathioprine metabolism is necessary to curtail its toxic effect. TPMT enzyme is responsible for this and SNP leads to increased drug toxicity.  PRSS1 – Mutations in this gene result in premature conversion of trypsinogen to trypsin leading to pancreatitis. Services Rendered Services 2016 2017 TATA box – Polymorphism in the promoter region of UDP glucuronosyl transferase 1 family, polypeptide A1 (UGT1A1) results in a defective enzyme leading increased unconjugated 369 448 bilirubin in circulation. MTHFR, Factor-II and Factor-V – The SNPs in these gene area ssociated with thrombosis disorders resulting in hypercoagulability. 134 366 ATP7B – Either of the 200+ mutations in this gene result in accumulation of coppoer in body parts and is classified as Wilson’s disease. 12 14 HFE – The polymorphisms in the gene are responsible for increased accumulation of iron in the liver. 5 4 SPINK1, CFTR – Both these genes are responsible for regulating the trypsin production pathway 69 62 in pancreas; mutations result in pancreatitis. JAK2 – Polymorphism in this gene is associated with Budd-Chiari syndrome often as a 178 158 complication of polycythemia vera. PNPLA3 – SNPs in this gene are associated with non-alcoholic fatty liver disease and steatohepatitis. 33 30 TPMT – The immune suppressant azathioprine metabolism is necessary to curtail its toxic effect. 54 45 TPMT enzyme is responsible for this and SNP leads to increased drug toxicity. PRSS1 – Mutations in this gene result in premature conversion of trypsinogen to trypsin leading to 9 34 pancreatitis Staff Faculty Designation Dr. Shvetank Sharma Associate Professor Technical Staff Surinder Kapoor, Dilip Newaria, Arun Thakur Academic and Research Achievements of Faculty Dr. Shvetank Sharma Complete faculty profile given under Dept of Molecular and Cellular Medicine.  Total Number of publications 22  Total Number of publications in 2017 8  Total No. of Projects 1 122

National Liver Disease Biobank Institute of Liver and Biliary Sciences (ILBS) has established The National Liver Disease Biobank (NLDB) with the support of DBT. NLDB is a National biobank facility for clinical and basic research in the field of HCV and other liver diseases. The prime objective is to provide biological resources for researchers to use its resources for better understanding of human health and disease. It can house close to 5.4 million bio-samples along with advanced analytical facility, including FACS, high resolution MS, NGS, and pathological analysis. The biobank will collect high quality samples with clinical data (including demographic, epidemiology, pathology, progression, vital status, and therapy and outcomes related data). Collection will be standardized; to ensure uniformity, consistency, and quality of collected data. Based on standardized data collection a model of informatics will be developed and utilization of resources/access to the advance research equipments will be made available to fulfill all the needs of researchers from start to end under one roof along with human resource training. This will be a nodal center to the clinical and basic researchers to carry out their research. This facility will provide a launch pad for advanced research in the field of HCV related liver diseases in India. It is operated by the Biobank core committee and operational management that are independent of host institute to ensure the neutrality. In order to deliver cutting edge services for collaborative liver disease research and academia-industry partnership in India, this facility will acquire a non-profitable business and financial model, where a nominal charges will be in place against the utilization of biobank services. It would also reduce the time and money engaged in the research project implementation. This will be a step forward in the direction of investigating biobanking-based science in India. 123

Major Initiatives Equipments: Ordering and tendering for material suppliers and installation experts for cryopreservation equipments (Liquid Nitrogen,-80 C deep freezer) and Analytical O equipments were made and six cryoshippers, Bio safety cabinet, Semi automatic Microtome and CO2 incubator with accessories were purchased. Selection and Recruitment: Posts for the Bio-bank staff were advertised and candidates were interviewed, selected and recruited. Software: Biobank software for management of biological sample with the implementation of barcode systems, Laboratory Information Management Systems (LIMS) AND collaborative tools for sharing biological sample collections are required for NLDB biobank. LIMS software specifications were identified and quotations were invited for tender process. Committees constituted Following Bio-bank committees were made for functioning of bio-bank:  Technical Advisory Committee for equipments.  Technical Evaluation Committee for equipments.  Executive cum-steering Committee.  Bio Specimen Release Committee.  Bio-bank Ethical Committee.  Recruitment Rules Committee.  Constitution Committee.  Selection Committee for Biobank Employees.  Screening committee for manpower application.  Training of internal and external DM (Hepatology) students.  Started new diagnostic panels for various malignancies and liver diseases.  Faculty presented research work in International conferences- AASLD, APASL, ILTS, EASL.  Faculty presented ILBS work in various National conferences and meetings- ISOT.  Faculty received travel grant support from ICMR, DST.  Faculty received financial approval and grant for project from DST.  DBT Grant received for national biobank project. Marketing and educational activities  Pamphlets, catalogues and Information Brochures are provided for institutes, hospitals and doctors for the awareness about biobank and distribution is under the process. 124

 Domain name for the website by the name of www.nldb.in was purchased.  Survey Questionnaires were prepared for Doctors/students and researchers for survey about the awareness of biobank.  Quotation from vendors received and finalised and development of the website is under the process.  Logo for the biobank has been designed and registration of the logo is under the process.  Accounts on social media i.e. Gmail, Linkedin, Twitter were made.  Official Contact made through personal visit, Email, Phone to directors of Government and Private Hospitals. Agreements and Forms Designed Following documents and agreements were made with consultation of legal advisor:  Confidentiality disclosure agreement  Application form unscheduled collection (CDA)  Information and Annexure  Collaboration agreement  Informed Consent  Material Transfer Agreement(MTA)  Hindi  Non-Disclosure Agreement (NDA)  English  Service Agreement  Service requisition form  Collaboration policy  Withdrawal of consent or Data  Application form scheduled Destruction form SOPs Designed Following Documents and Agreements were made with consultation of legal advisor:  SOP for Administration  SOP for Participant and Recruitment Management  SOP for Records and Documentation Management  SOP for Facilities Management / Operation  SOP for Quality Assurance Procedures  SOP for Safety  SOP for Training  SOP for Materials Handling and Documentation  SOP for Material Release Potentially available source for biosamples Formalin Fixed Tissue Samples from 1326 patients were identified in ILBS and all samples were linked with their demographical, clinical and pathological data. 125

Samples Quantity Gall bladder 391 Liver 93 Explant liver 350 Wipple's 76 Gastric with other 416 Total 1326 Collaborations We proposed our objectives to different hospitals across Delhi and NCR and got positive response for collaboration from following hospitals/institutes:  Army Research and Referral Hospital  Shri Balaji Action Medical Institute  BLK Super Speciality Hospital  Medanta-The Medicity Staff Faculty Designation Dr. Chhagan Bihari Associate Professor Other Staff Dr. Birendra Kr Yadav (Bio-bank Manager), Koustav Mallick, Satish Kumar, Amit Kumar Rathore, Manpreet kaur, Shivani Goel, Indrajeet Kumar Academic and Research Achievements of Faculty Dr. Chhagan Bihari Complete faculty profile given under Dept of Pathology.  Total Number of publications 100  Total Number of publications in 2017 17  Total No. of Projects 2 126

127

Transfusion Medicine 128

Transfusion Medicine Transfusion Medicine Our Mission: “To provide safe and quality transfusion products and services timely, as well as contributing to education, research and training of medical and paramedical personnel in the field of transfusion medicine so as to benefit the overall well being of the patient” .  The Department of Transfusion Medicine is committed to provide the highest quality of Transfusion support both in terms of diagnostic and therapeutic modes of treatment round the clock and advanced Immunohematological testing to the patients and the donors. Brief outline of the department and its role in the hospital are mentioned as under:  We appreciate and encourage voluntary donors by increasing the awareness and education regarding blood donation and also honour them.  The second most important aspect is to provide safe units in terms of transfusion transmitted infections for which we have a highly sensitive screening test based on the principle of chemiluminescence to reduce the number of false negatives.  The third important aspect is precise serological testing in patients and donors samples for which we have gel techniques, extended phenotyping and antibody screening and typing facilities which enables us to select the best match unit for the patient.  The fourth important aspect is the therapeutic mode of intervention for which we have the facility of plasma exchange, cascade plasmapheresis, therapeutic apheresis and therapeutic phlebotomy.  To sub serve the aforementioned aims we have a dedicated and a well trained staff who all hold patients overall well being in the highest regards and adhere strictly to SOPs (standard operating procedures) and GMP (good manufacturing practices). 129

Services Rendered Services 2016 2017 Donor grouping 8581 8105 Donor ICT 8581 8105 Donor Du 589 583 Patient grouping 4154 3867 Patient ICT 3245 2983 Patient DCT 1497 1261 Patient Du 218 204 Plasma Exchange 224 163 Liver transplant workup 475 437 Cross matching 13450 12325 Donation 8039 7567 Transfusion Transmitted Infectious (TTI) marker done 8581 8105 Leucodepleted PRBC (LD-PRBC) prepared 8039 7567 Fresh Frozen Plasma (FFP) prepared 6632 7277 Random Donor Platelet Concentrate (RDPC) prepared 4064 3360 Leucodepleted RDPC (LD-RDPC) prepared 293 267 Leucodepleted SDPC (LD-SDPC) prepared 503 460 Cryoprecipitate (CRYO) prepared 3029 1985 Cryo Poor Plasma (CPP) prepared 3029 1985 Leucodepleted PRBC (LD-PRBC) issued 7155 6558 Fresh Frozen Plasma (FFP) issued 8285 4919 Random Donor Platelet Concentrate (RDPC) issued 3718 2727 Leucodepleted RDPC (LD-RDPC) issued 293 267 Leucodepleted SDPC (LD-SDPC) issued 470 443 Cryoprecipitate (CRYO) issued 2968 2580 Cryo Poor Plasma (CPP) issued 1159 1332 Antibody identification 54 57 Antibody Titer 81 104 ABOi 4 0 DFPP 19 5 Therapeutic platelet reduction 1 0 Therapeutic Phlebotomy 15 4 Granulocytapheresis 0 3 Immuno-Adsorption 0 1 New Services and Facilities  Secondary plasma device procedures, Granulocytapheresis, Immunoadsorption 130

Course Offered Courses Candidates Admitted Candidates Passed PDCC in Immunohematology and Blood Banking Dr. Brinda Kakkar Dr. Akshay Batra Immuno-Adsorption Dr. Akshay Batra Dr. Sukanya Baruah Donor Du Dr. Sukanya Baruah Department’s Achievements  Dr. Sweta Nayak presented oral paper, poster and lecture at Transmedcon 201, Lucknow  Dr. Sweta Nayak attended the program “ Training of Trainers” on red cell alloantibody screening as Demonstrator, at National Institute of Biologicals, Noida.  Dr. Brinda Kakkar attended a CME on Paediatric Transfusion Medicine Practice, August 2017, Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida, Uttar Pradesh, India.  Dr. Brinda Kakkar presented poster at 5th Annual Conference of Indian Society of Transfusion Medicine, Lucknow, India, TRANSMEDCON 2017.  Original article accepted for publication of Dr. Brinda Kakkar in Asian Journal of Transfusion Science on 19th November 2017.  Mr. Pankaj Jain was invited as a resource person in pre-conference workshop on Advanced Immunohematology at TRANSMEDCON 2017 Lucknow held in November 2017.  Mr. Pankaj Jain attended a two day workshop on POI on NABH Blood Bank held in September 2017. Staff Faculty Designation Dr. Meenu Bajpai Additional Professor Senior Residents Dr. Sweta Nayak, Dr. Durre Aden, Dr. Brinda Kakkar Technical Staff Jacob John, Prakash Kandpal, Govind Kumar Pandey, Pankaj Jain, Girish Kumar, Vijay Kumar Parewa, Sushil Pawar Academic and Research Achievements of Faculty Dr. Meenu Bajpai Dr. Meenu Bajpai is presently Additional Professor and Faculty-in-Charge of Department of Transfusion Medicine at ILBS. She did her MD in Transfusion Medicine from Post Graduate Institute of Medical Education and Research, Chandigarh. She also did her Senior Residency from the same Institute, following which she did Senior Research Asscociateship from All India Institute of Medical Sciences, New Delhi for a short period. She has worked on platelet 131

antibodies in hemato-oncology patients as a part of her MD and on irregular antibodies in neonates with hemolytic disease of newborn as SRA. She was awarded Princess of Wales Scholarship by the British Blood Transfusion Society in 2009 and the Harlod Gunson Fellowship by the International Society of Blood Transfusion in 2011. She has been working as faculty at the Institute of Liver and Biliary Sciences since 2008. She is Assistant Editor of Asian Journal of Transfusion Sciences since 2011. She is the Nodal Officer for Hepatitis day awareness program organized by the Institute. She is a course faculty for the WHO CC centre at the Institute. She is presently working in various committees of the Institute. She also looks after procurement at ILBS as purchase officer. National Leadership  Member of the committee for the prevention and management of hemoglobinopathies under NHM, MoHandFW GOI.  Contributor to “prevention and control of hemoglobinopathies in India” published by NHM, MoHandFW GOI.  Member of the committee for the guidelines for the blood storage centers under NHM, MoHandFW, GOI.  Contributor to Bed-side transfusion guidelines recently circulated by MoHandFW GOI on 15 December 2017.  Contributor to the Training Manual – “Training of Trainers for strengthening of blood services ande-Raktkosh” published by NIB, NHM, MoHandFW GOI.  Member of the Signal Review Committee of Hemovigilance Programme of India under NIB (MoHandFW).  Resource person for the Haemovigilance Programme of India under NIB, MoH and FW GOI.  She is an executive member representing North India of the India chapter of Asian Association of Transfusion Medicine (AATM).  Total Number of publications 17  Total Number of publications in 2017 1 Conferences attended 1. Invited as a guest faculty at 6th Annual Conference of Indian Society of Transfusion Medicine (ISTM) TRANSMEDCON 2017 being held from 3rd to 5th November, 2017 at Hotel Taj Vivanta, Lucknow to give a talk on “Transfusion support in ABO incompatible solid organ transplant”. 2. Invited as a speaker at 9th Annual meet of Odisha Hematology 2017 being held on 18th and 19th November 2017 at Burla, Sambalpur Odisha to give a talk on ‘Transfusion support in alloimmunized patients with Sickle cell anemia’. 3. Invited as a guest faculty at 42nd ISBTI National Conference of ISBTI “TRANSCON 2017” organized at Education City of Kota from 08th to 10th Dec. 2017 to give talk on “Transfusion support in liver transplantation”. 132